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Studies on the quantitative expression of the Major Histocompatibility Complex (MCH) in hepatocytes chronically infected by Hepatitis B Virus (HBV) report that an increased expression of these antigens could be related to a good immunological response. In the present work we analyze the expression of the MCH antigens in cryostatic sections of liver biopsies taken from subjects (19 children) with various forms of HBsAg positive chronic hepatitis. A high expression of HLA class I antigens and a high degree of hepatocyte necrosis was evident in Chronic Active Hepatitis (CAH) and Chronic Lobular Hepatitis (CLH). On the contrary, subjects with histological diagnosis of Chronic Persistent Hepatitis (CPH) showed a low expression of such antigens. There was however, the difference that in subjects with high hepatic cytolysis and high expression of HLA class I antigens, serum HBV-DNA was clearly present in almost all the cases with CAH, but not detectable in all cases with CLH. The expression of HLA class II antigens and of Beta2 microglobulin was the same in all 19 cases. All cases with HBV-DNA positivity with high class I antigen expression had active hepatitis which seems to suggest that all attempts at viral clearance on the part of the immune system have been in vain. We hope our paper will be an additional parameter for evaluating the course of hepatitis during Interferon treatment.

The Authors studied the behaviour of ABsAb in a pediatric case-list made up of 8 cases of virus B acute hepatitis, and 63 cases of chronic hepatitis in different evolutive phases: besides, this investigation was extended to 48 healthy carriers (29 of whom bioptically confirmed) and 35 cases of cohabitants with HBsAg-positive hepatic chronic patients. In acute hepatitis the antibody pattern, even if delayed in time, mimics the modalities of the organic response against exogenous stimulations, therefore it constitutes an index of past disease and recovery. In chronic hepatitis (both HBsAg-positive and negative) the specific antibody to the surface antigen is present only at a low percentage (27%) and generally at low titres. In healthy carriers, bioptically ascertained, it is practically absent as to suggest more careful consideration when it turns out present (pseudo-carriers?), while in the cohabitants with virus B patients, especially if chronic, along with HBsAg detection, it consitutes an indispensable element for their classification in patients, ex-patients, not infected and healthy carriers. A very interesting finding, requiring further confirmation, is the unusual behaviour of these antibodies in some cases of relapsed chronic hepatitis.

The authors have performed a longitudinal study of 118 children affected with B virus chronic hepatitis. Our first observation revealed 92 children with HBeAg positive (26 CPH, 66 CAH), 22 children with anti HBe positive (6CPH, 15 CAH, 1 cirrhosis), 4 children (CAH) with e/anti-e negative. A correlation between the severity of clinical forms and the behaviour of the e/anti-e system was not observed. Seroconversion was observed during the follow up period in 37 of 92 subjects in an average time of 59.83 +/- 32 months, time rather prolonged in patients under immunosuppressive therapy. To compare the clinical progress and the evolution of CPH and CAH respectively, always with regard to the e/anti-e system, statistically significant differences did not result. Only anti HBe positive recovered subjects, inclusive of seroconverted patients and those anti HBe from the first observation, showed significant results to the statistical analysis. Still, seroconversion corresponds frequently to a stable improvement of hepatitis. On the contrary evolution into cirrhosis was observed in 5 patients that had anti HBe antibodies.